Health related information and news from around the world.

There are now some blood tests (RAST tests) which can determine specific allergens. There is still some doubt about their accuracy. Other blood tests show a rise in the amount of globulin, the blood protein concerned with immunity.

Treatment of asthma will depend on its severity. There is no cure but control is possible. Mild or occasional asthma will only require treatment for the acute attack.

Many drugs are used and are designed to dilate the constricted bronchial tubes. They can be taken by mouth, by suppository (absorbed through the rectum), by injection into the muscles or directly into a vein, or inhaled into the lungs.

Most are related to adrenalin and tend to make the heart beat faster and the person feel jumpy.

Children often vomit with asthma and so, in an acute attack, cannot take medicine by mouth.

The development of the metered spray has made treatment so much better and drugs can be delivered in small doses directly to the target tissue.

Some of these bronchodilator medicines are used not only for an acute attack but also on a regular basis for prevention.

*212/71/1*

Jacqui is a patient who for years suffered from infertility problems related to endometriosis. After surgery and medication, she was able to conceive two children. Now it appears that her disease is under control. When Jacqui came for a routine examination last spring, she mentioned that her sister was taking high-dosage birth control pills.

“Franny has been telling me how bad she’s been feeling”, Jacqui said. “I think of myself when I hear her—I could swear that the symptoms sound just like she’s got endometriosis. Franny never had any problems like cramps and pain before starting the Hill. She’s got a bit of a weight problem, and that worries me, too. What are the chances that the Pill is giving her endometriosis?”

Birth control pills do not cause endometriosis. In fact, they were once considered the treatment of choice to control the disease. Oral contraceptives are a balance of estrogen and progesterone, and the pills vary in formula and dosage. Although we know that estrogen influences the growth of endometrial cells, it has not yet been implicated in creating mutant cells that may become endometriosis. Let’s take the next step. If we examined under a microscope the endometrial tissue of women on oral contraceptives, we would find that the cells have become somewhat abnormal. This abnormality renders them inactive; that is, as a result of retrograde menstruation, they will not implant themselves on host organs and grow there.

About half of all such women, in fact, have suffered from some form of uterine cancer. High-fat or cholesterol-laden foods are most responsible for weight gain, and researchers are finding that these treacherous tats have the ability to convert into estrogen or stimulate hormone production. Greater production of estrogen influences buildup of the endometrium, causing a heavier menstrual flow.

A family predisposition to the disease could be conclusive here. There is a good chance that Franny already had endometriosis before taking oral contraceptives. The likelihood it that the estrogen in the pill stimulated the growth of endometrial cells to a certain degree. And since being overweight has been connected to higher levels of estrogen, we would strongly recommend that Franny keep her weight down.

Women with Jacqui and Franny’s history of endometriosis may find themselves facing a problematic option upon reaching menopause: should they have hormone replacement therapy? Such hormone therapy, in the form of estrogen supplements, is prescribed to control hot flashes, loss of vaginal elasticity, and other signs of aging related to lowering of female hormone levels. Mild endometriosis can occur as a result of estrogen replacement therapy, and this is not just the case with lifelong sufferers, women without any disabling symptoms of the disease may find that the estrogen has activated dormant cells. Jacqui and Franny, and women who share their problem, may have to battle a recurrence of the disease when they reach menopause. Perhaps by that time, however, doctors will have found a cure that trees a woman from the disease throughout her lifetime.

Scientists seeking the organic causes of endometriosis have scrutinized genetics, chemistry of the body, the influence of stress, distress, and the tempo of a woman’s life, hormonal responsibility, and even emotional attitudes. Sometimes there is great excitement in a laboratory or a doctor makes an astute observation and our knowledge of endometriosis is increased. Each quest for information brings us closer to the answer of why. Progress is being made. Until we can cite the precise components that cause endometriosis, we can work with effective methods for controlling and preventing the disease. That begins with you: your body will tell you what’s wrong, but you must be able to communicate your symptoms to a doctor. For now, let’s take the emphasis off why and learn what you can do to help yourself by understanding the disease more fully.

*36\43\4*

A variety of animals—both domestic and otherwise—are known to transmit diseases to man. Several bacterial infections which affect humans may be contracted from animals. Domestic dogs and cats, being the most popular of household pets, are especially likely to be implicated in this regard. Both staphylococcal and streptococcal germs are carried in the mouths and throats of dogs and cats, and are easily transmitted to their owners. As well as transmitting their own infections to man, pets may also convey infections they themselves have acquired from man back to man himself.

Brucellosis is a bacterial infection of cattle, sheep, goats and pigs. This may he contracted by humans, either through contact with infectious milk or directly from the infected animals. In addition to skin infections, brucellosis may cause a high fever and muscle pain. Another bacterial disease, anthrax, is contracted from the handling of infected bones, hides, wool or hair of animals. The disease may cause severe pustular infections, associated with very high fever, and may be fatal. Cat-scratch disease, which usually results in painful, enlarged lymph glands and rashes, may be contracted as a result of being scratched by an infected cat or kitten. Tropical fish enthusiasts are not immune from infection either. The water in tropical fish tanks is often contaminated by the bacteria Mycobacterium marinum, which closely resembles the tuberculosis germ. It may also be present in lakes or heated swimming pools. Infection usually occurs at the site of an abrasion. It appears as a lump or infection, which breaks down to form a non-healing sore. Most commonly, ft occurs on the hands. Treatment with the appropriate antibiotic is most satisfactory.

Similarly, there are a number of viral infections of animals which may affect humans. These include ornithosis, a most unpleasant disease which may affect the lungs, heart or liver, and cause a fever and a fairly characteristic rash. Another viral infection, foot-and-mouth disease, is common in European and Asian farm animals. Rarely, however, does it infect man. When it does, it results in blisters of the mouth, tongue, lips and the palms and soles. It tends to be more severe in infants and children than adults. The disease milkers’ nodule is derived from the teats of infected cows, and results in tender, red lumps on the fingers of those who milk these cows. Orf is a similar condition, mainly derived from lambs. It infects humans, either through their direct contact with the affected animal, dead or alive, or even through contact with contaminated pastures. It results in painful nodules on the hands which may ulcerate.

Animals are also known to transmit a number of fungal infections to man. Four of these infections are frequently causes of ringworm; they are: microsporum canis, commonly found on cats and dogs; trichophyton verrucosum, commonly found on cattle; trichophyton men tagrophytes and microsporum gypseum, soil inhabitants. (Ringworm is discussed in detail on page 73.1 There are other fungal infections which not only infect the skin but the internal organs as well. Fortunately—for they are difficult to treat—such infections are rare. In Australia there are three forms which are known to affect man: sporotrichosis, blastomycosis and cryptococcosis.

Certain parasites harboured by our pets may be transmitted to us accidentally; these parasites may be a source of irritation in themselves, or they may be carriers of some disease. One of the more serious of these parasite-transmitted diseases is hydatids. Normally, the tapeworm responsible for the disease lives in the intestine of the dog and if its eggs are accidentally swallowed by man, large hydatid cysts develop internally. The common intermediate host is the sheep, which may eat infected grass. Other parasitic worms which may affect humans are cat or dog hookworms. These may be picked up from infested soil, the worms depositing larvae which are able to penetrate the skin. This results in a characteristic creeping eruption. Similarly, swimmers itch is caused by penetration of the skin by the larvae of bird worms. This is usually picked up in shallow lakes from snails, which are the intermediate hosts. Another infection, leptospirosis, is an infection caused by a parasite frequently found in domestic animals (including dogs, pigs and cattle) and rats. Humans are usually infected by contact with infected urine via a cut or an abrasion. The resultant illness may be experienced as a mixture of fever, muscle pain, rashes, headaches and jaundice.

*64\44\4*

Fibre probably has an important effect on satiety. In one study researchers showed that a high-fibre breakfast, including 20g of soluble and insoluble fibre, significantly suppressed ad libitum lunch energy intake 4 hours later when compared with a low fibre breakfast. There was, however, no significant effect on total energy intake for the day.

Other studies have found increased feelings of fullness for 3-4 hours after eating high-fibre breakfast cereals. The highest scores always corresponded to the highest fibre content. Because fibre does not seem to limit consumption at the test meal it seems that the appetite benefits of eating fibre emerge at the next meal rather than the current meal. That is, fibre has a bigger effect on satiety than satiation. However, simply adding fibre supplements to a high-fat diet is not likely to have the same effect as eating a selection of high-fibre foods. This is because the fibre in supplements is not ‘bound’ to the nutrients in the food consumed.

*117\186\4*

Most women with endometriosis have felt anger at some stage. It may happen after you overcome the initial confusion and feelings of isolation because then you start asking yourself: ‘Why me?’, ‘Why am I infertile?’, ‘Why didn’t doctors pick this up sooner?’, ‘Why isn’t there a cure?’, ‘What research is being undertaken?’, ‘Why isn’t more information available about this disease?’.

With all these questions racing through your mind it is difficult to realise that you have not been singled out to suffer. You will feel angry that at some stage this disease may interrupt your life or that it may prevent you from having children, or attaining other goals in your life or pursuing some sporting interest or hobby.

You may also feel angry because endometriosis is a chronic disease for which there is no ‘cure’. You may be angry because a diagnosis has taken so long, because doctors do not have all the answers and it seems that no-one understands your turmoil.

Your partner too may be confused and frustrated by the disruption the disease has caused to your lives. He may feel angry that there is no cure, or may find it difficult because you may need his constant support.

How do you cope with this anger and frustration that you both may feel?

Try to include your partner in talks about the disease. Encourage him to accompany you on visits to the doctor or to meetings of support groups.

Let your partner talk about his fears and concerns and include him in any decision making.

*106\83\2*

For the majority of women with endometriosis the initial decision regarding treatment is whether to have hormonal or surgical treatment. Ideally, you should make this decision yourself in consultation with your gynaecologist.

The reasons for selecting a particular treatment vary widely and will depend on a number of factors including:

Extent and severity of the endometriosis

Size and location of the endometrial implants

Extent and location of any adhesions

Nature and severity of symptoms

Duration of any infertility

Desire for future childbearing

Age

Whether or not related problems exist

Success of previous treatments

Your preferences

The preferences and practices of your gynaecologist.

If you have minimal to moderate endometriosis, hormonal treatment is usually recommended. In contrast, if you have severe endometriosis you are more likely to have surgical treatment although hormonal treatment may still be appropriate if you do not have any large cysts.

If you have any adhesions or endometriomas greater than two centimetres in diameter, these can only be removed surgically as hormonal treatment has no effect on adhesions or large endometriomas.

Some women choose hormonal treatment rather than surgery because they do not want to have their lives totally disrupted for several weeks while they recover from an operation. Others choose hormonal treatment because they feel that it is a less drastic form of treatment or because they do not like the idea of having surgery. Some women do not want surgery because they do not want to take the risk of developing adhesions which surgery can cause.

Some women choose surgery because they do not want to delay trying to conceive for another six to nine months while they are having hormonal treatment. Others may have already experienced intolerable side effects from previous hormonal treatment and would rather try surgery. Others simply do not wish to use drugs or are concerned about the possible long-term effects of hormonal treatment.

*47\83\2*

There are essentially two main ways of reducing stress:

To identify the sources of your stress and where possible seek either to reduce or eliminate these; and/or

To find ways to enable you to cope better with those sources of stress you can neither reduce nor avoid.

The most effective way to get your stress level down is usually by working towards both of these aims simultaneously. These tips from the experts will help you do just that:

Much stress is linked to always being in a rush, to constantly fighting the clock to get everything you need to do completed in time. Plan your day more carefully, allow yourself enough time for what you must do and so meet deadlines more gracefully, and you’ll find this cuts out a great deal of stress.

Directly linked to the above is the recommendation that you should be careful not to set yourself unrealistic targets, especially those that you know beforehand you will probably be incapable of meeting or where you will only manage to do so by rushing like mad or cutting corners, this being a sure-fire recipe to push up your stress level.

Always think things through carefully before you act or commit yourself to a course of action. Impulsive and less than well-thought-out actions are frequently the source of subsequent regrets, and the latter can be extremely stressful.

Set aside time to relax both physically and mentally for at least a part of every day, no matter how busy your schedule may be.

Retain control of your own life by learning to say ‘no’ if saying ‘yes’ would commit you to what is likely to become a stressful situation.

Whenever possible, take a break now and then, as a change of routine can recharge your mental and emotional batteries and improve your resistance to stress, thereby effectively reducing your level of it.

Learn to accept sensible limitations. If something is beyond your control, accept it as gracefully as possible until the time comes when you can do something to change it for the better. Agonising and worrying about things that can’t be helped is a major cause of stress and can also be a precursor to chronic anxiety.

*53\124\2*

There are many ways of tackling or managing stress, and mastering these techniques inevitably pays off by promoting an antidepressant lifestyle. Improving interpersonal skills, for example, is one way of reducing the feeling that others are a constant source of unavoidable and uncontrollable stress. When I first began to supervise research assistants, I would observe that they often seemed harried and anxious. On one occasion, as a result of a shuffling of government personnel, a senior manager was temporarily assigned to me as a research assistant. I delegated several tasks to him and, after the first week of working under my direction, he asked to meet with me. He explained that the number of tasks I had assigned him were more than he was able to manage competently in the course of his working hours. Would I be good enough, he asked, to indicate to him my priorities so that if he was unable to complete all the tasks by the week’s end, only the least important task would remain undone. This research assistant taught me two invaluable lessons: Not only did I learn to become a better manager, to set priorities and be more realistic about what could be accomplished in the time available, but I learned how someone who is subordinate in an organization can politely set limits and manage his or her level of daily stress. If you are feeling under pressure at work, take some time to analyse the situation. Make a list of all the sources of stress and then try to figure out solutions to each of them. It is in the interest of the other parties involved to have these stresses resolved as well. Consider ways of presenting the problem to your boss, co-workers or even those working for you in such a way as to point out how it would be mutually beneficial if the stresses could be alleviated. For example, the final product might be superior, production might be more efficient, or the working environment more conducive to creativity or productivity. All of these goals can be legitimately presented as being in the interests of both workers and management.

Exactly the same principles apply in a marriage or other type of relationship, only more so. In these situations all parties involved usually have major investments at multiple, different levels. For example, in a marriage or relationship it is in both parties’ interests to get along, not only because it is more pleasant to do so, but also for the sake of mutual investments in the form of children and other common goals. Once again sources of stress can be identified and communicated to your partner, and if this is done in the right way the outcome can diminish levels of stress, relieve the tension in the relationship and promote an anti-depressant lifestyle. The key is always to present the situation as a shared issue which it would benefit both individuals to solve together. Let us say, for example, that a husband comes home from work and goes straight to the fridge for a can of lager, ignoring his wife in the process. She is bound to feel neglected, angry and perhaps depressed. At this point she has a choice. She can attack her husband for his callous and brutish behaviour or she can take a more collaborative approach. Attacking him may make her feel better in the short run but is bound to make the problem worse. A collaborative approach may have a better chance of working in the long run. This could involve: (1) empathy – ‘I understand that you are stressed and tired at the end of a hard day’; (2) communication of her feelings – T feel the same way after running after the kids all day’; (3) involving him in solving the problem – ‘Can you think of some way that we can unwind together?’; and (4) demonstration of what’s in it for him to do so – ‘so that we can support each other at difficult times and maybe even figure out a way of having some fun in the process.’ Obviously the way in which she chooses to handle the communication is likely to influence the outcome of the evening and either exacerbate or ameliorate her depression.

Part of the skill involved in such communications is picking the right time. A perceptive husband might recognize, for example, that the three days before his wife’s period are not the best time to discuss the large charges they have run up on the credit card. Conversely, an insightful wife learns to discern her husband’s moods and bides her time before discussing with him how she could use more help from him around the house or with the children.

It is also important to recognize that depression frequently causes stress in a relationship. This is of course an additional reason to treat the depression biologically. The partner of the depressed person often feels neglected. Feelings of depression can be contagious and there is a natural tendency to want to avoid a depressed person, which can isolate the person further and deepen the depression. There are some important pointers for the partner or family member of a depressed person to bear in mind. First, don’t take the depression personally. It is not your fault. Frequently the family member feels responsible for the depressed person’s mood, which makes him or her angry since at times nothing seems to cheer the depressed person up and there is a tendency for friends and family members to give up on the depressed person and withdraw. Second, it is not your responsibility to turn the depressed person’s mood around. You can and should be supportive. It is particularly worth trying to help your friend or loved one get appropriate assistance. But you cannot expect to have a direct effect on the other person’s mood. It is too much of a burden to place on yourself and is bound to leave you feeling resentful. Finally, don’t ignore the depressed person and enhance his or her sense of isolation. Do what you can to include the person in activities in a non-demanding way. For example, a husband might suggest going out to a restaurant for dinner with his wife, who may feel cheered up by the food, the setting and the friendly attention. On the other hand, suggesting that it might cheer her up to have guests over is unlikely to have its intended beneficial effect because of the demands this will place on her to perform and be sociable, which might be the last things in the world that she feels like doing.

There is a great deal that a depressed person can do to keep his or her loved one involved even while in a depressed state. Simply acknowledging the depression and its impact can be helpful. For example, a wife is likely to respond favourably to her depressed husband if he says T know I have been down and not much fun lately, but I am trying to turn things around as best I can. Thanks for hanging in there with me.’ The partner of a depressed person becomes starved for any positive feedback and comments such as this are generally greatly appreciated. Even if you are feeling sad and detached, as is often the case when one is depressed, it pays to make a point of expressing appreciation to your friend or loved one for gestures of kindness. It can be also useful to pinpoint specific things that your loved one can do that would make you feel better. This helps him or her to feel useful and counteracts the powerlessness typically experienced by those who surround and care about a depressed person.

So important are interpersonal skills in helping people overcome and avoid depression that an entire type of psychotherapy for depression, called Interpersonal Therapy, has been developed around these principles.

There are many types of stress other than interpersonal difficulties which may confront a depressed person and make matters worse. These include physical illness, financial difficulties and loss of a loved one. For all these different types of situations, help can be obtained from different types of experts, for example a sympathetic and competent doctor, a financial advisor or a religious or spiritual leader. A good doctor should not only provide specific help for symptoms but also comfort and reassurance. I have seen people in serious financial difficulty who have been greatly relieved after turning their affairs over to a debt counsellor or obtaining help and guidance from a financial planner. And innumerable people have been comforted and supported over the centuries by their priests, ministers or rabbis. Of course, caveat emptor applies whenever one turns to any guide or authority figure for help. Ultimately you have to be the judge as to whether a so-called expert is helping you or not. As always, stay tuned to your mood barometer to judge the quality of assistance you are receiving.

*68\75\2*

The incidence of a disease means the number of new cases in a defined population (usually

100 000) in a defined period of time (usually one year).

Good figures for the incidence of new cases of epilepsy come from the population of Olmstead County in Minnesota. People in this rural part of the USA do not move around very much, and have the good fortune to be cared for by doctors at the famous Mayo Clinic. Research workers there have long had an interest in identifying all patients with epilepsy.

The incidence of new cases is highest in infancy and in old age, but new cases can occur at any age. Throughout middle life the incidence is about 40 cases per 100 000 per year. As the years go by, the risk of having had epilepsy at some time in one’s life increases in a cumulative fashion. The cumulative incidence in a population of children studied in the UK was 410 per 100 000 by the age of eleven, 600 by the age of 16, and 1000 per 100 000 by the age of 23. From the United States study cited above, the cumulative risk by age 75 was 3400 per 100 000 (3.4 per cent) for males and 2800 per 100 000 (2.8 per cent) for females. Epilepsy is thus not a rare or unusual disorder; seizures may impinge upon the lives of any one of us.

Another word used in counting cases of disease is prevalence. Here it is best to consider first another common illness which has a prolonged and steady course such as Parkinson’s disease. It is quite easy (though expensive) to do a door to door survey and count the people found to have Parkinson’s disease, as the signs of it will always be apparent. Prevalence is usually expressed per 1000. The prevalence of cases per 1000 population means that this number of people have the disease on the day of the survey. This technique is more difficult for epilepsy because of its episodic nature. Clearly, common sense dictates that if someone had a seizure during a day on which a survey day was done, they should be included, but what about someone who had many seizures in the past, but none for three years? One has to judge where to draw the line. In practice, most surveys of prevalence include people who have had more than one non-febrile seizure in the past, and are on continuing anti-epileptic drugs and/or who have had at least one seizure in the last two years. After early childhood, the prevalence is more or less constant throughout life at about seven per 1000 in developed countries, and considerably higher in developing countries.

*7\188\2*

An itching rash covered in tiny blisters may occur at points of contact with watch bands, ear rings, and costume jewelry, and then spread widely over the surrounding skin in people who have become sensitive to nickel. This is much more likely to occur when there is excessive perspiration, so that the skin is moist at the point of contact with the metal. In some cases, furthermore, the dermatitis becomes so widespread that it is mistaken for scabies.

The latest news about nickel, Cutis (35#5:424) reports, is the mysterious appearance of dermatitis on the abdomen just below the umbilicus. Eventually, its cause was found to be contact with nickel buttons on blue jeans. In many cases, the dermatitis had also spread to other parts of the body. More often than not, treatment of this condition involves nothing more than replacing the button, watch band, etc., with an item made of another material. If the rash is severe and widespread, however, a visit to the dermatologist for special medication is required.

*197\143\2*